双侧输卵管切除与双侧输卵管阻塞对体外受精-胚胎移植结局影响的系统评价

目的探讨双侧输卵管切除与阻塞对体外受精-胚胎移植(IVF-ET)结局的影响,并评估其临床价值及前景,为因输卵管因素采用辅助生殖技术的患者提供临床依据。方法全面检索VIP、CBM、万方数据库、CNKI、PubMed数据库、Ovid数据库,提取双侧输卵管切除与双侧输卵管阻塞对IVF-ET结局的影响随机对照试验及临床回顾性研究,提取数据资料,对所纳入文献进行系统评价,使用Revman5.2软件进行Meta分析。结果共纳入11个研究,合计共1 973例患者,其中有明确双侧输卵管切除手术史的有576例,经腹腔镜或子宫输卵管造影检查证实输卵管阻塞的有1 397例患者。Meta分析结果显示,在IVF-ET治疗中,两组所纳入患者年龄差异无统计学意义(P=0.1);输卵管切除组与输卵管阻塞组使用促性腺激素(Gn)用药量比较,差异无统计学意义[MD=2.13,95%CI(-0.27,4.53),P=0.08];Gn用药时间,输卵管切除组较输卵管阻塞组用时长,两者存在显著性差异[MD=0.19,95%CI(0.00,0.38),P0.05];获卵数输卵管阻塞组比输卵管切除组多,两者存在显著性差异[MD=-2.18,95%CI(-4.20,-0.17),P=0.03];但两组妊娠率无显著性差异(P=0.70)。结论在采用同一种促排卵方案的情况下,输卵管切除患者在进行辅助生殖技术时使用Gn时间更长,但获卵数较少,而两组Gn用药量及单次临床妊娠率无显著差异,提示输卵管性不孕患者在行IVF-ET前行输卵管切除可能会引起卵巢低反应性。

Systematic evaluation of effects of bilateral salpingectomy and bilateral tubal occlusion on clinical outcome of in vitro fertilization and embryo transfer

Objective：To explore the effects of bilateral salpingectomy and bilateral tubal occlusion to the clinical outcome of in vitro fertilization and embryo transfer（IVF-ET）.Methods：The literatures about the effects of bilateral salpingectomy and bilateral tubal occlusion on the outcome of IVF-ET in the randomized controlled trials and retrospective studies were searched from VIP,CBM,Wanfang database,CNKI,PubMed database,Ovid database.Then the literatures were systematically evaluated by Mata analysis with Revman 5.2.Results：Eleven literatures including 1 973 patients were selected for Meta analysis,of which 560 patients had surgical history of bilateral salpingectomy and 858 patients suffered from bilateral tubal occlusion confirmed by laparoscopy or hysterosalpingography.Meta analysis showed that there were no significant differences in age（P=0.1）and the dose of gonadotropin（Gn）used [MD=2.13,95%CI（-0.27,4.53）（P=0.08）.The duration of Gn was significantly longer [MD=0.19,95% CI（0.00,0.38）（P〈 0.05] and the number of oocytes retrieved was significant higher in bilateral tubal blockage group [MD=-2.18,95%CI（-4.20,-0.17）]（P=0.03）.The pregnancy rates in two groups were no significant difference（P=0.70）between the patients with bilateral salpingectomy and the patients with bilateral tubal occlusion.Conclusions：Under the same stimulation IVF-ET protocol,the duration of Gn used is longer,but the retrieve oocytes are fewer in the patients with salpingectomy than the patients with tubal occlusion,which indicates that the patients with salpingectomy before IVF-ET may cause ovarian low reactivity.